<!DOCTYPE html> 
<html>
    <head>
	<meta charset="utf-8">
	<meta name="viewport" content="width=device-width, initial-scale=1"> 
	<title>Contact</title> 
	<!Librairie JQuery mobible>
        <!--<link rel="stylesheet" href="http://code.jquery.com/mobile/1.0/jquery.mobile-1.0.min.css" />-->
           <script src="http://code.jquery.com/jquery-1.6.4.min.js"></script>
        <script src="http://code.jquery.com/mobile/1.0/jquery.mobile-1.0.min.js"></script>
        <script src="http://code.jquery.com/mobile/latest/jquery.mobile.min.js"></script>
    
         <script src="http://code.jquery.com/jquery-latest.js"></script>
    </head>
    
    <body> 
        <div data-role="page">

            <div data-role="header" data-theme="d">
                <h1>Contact</h1>
            </div>

            <div data-role="content" data-theme="d">    
                <div data-role="fieldcontain" class="ui-field-contain ui-body ui-br">
                <label style="margin-top: -15px" for="select-choice-a" class="select ui-select">Raison :</label>
                    <div class="ui-select">
                        <div>
                            <select name="select-choice-a" id="select-choice-a" class="ui-select-nativeonly">
                                <option value="standard">Question</option>
                                <option value="rush">Feedback</option>
                                <option value="express">Plainte</option>
                            </select>
                        </div>
                    </div>
                </div>
                
                <div data-role="fieldcontain" class="ui-field-contain ui-body ui-br">
                    <label style="margin-top: -15px" for="name-a" class="ui-input-text" >Sujet :</label>
                    <input type="text" name="name" id="contactSujet" value="" class="ui-input-text ui-body-a ui-corner-all ui-shadow-inset"/>
                </div>  
                
                <div data-role="fieldcontain" class="ui-field-contain ui-body ui-br">
                    <label style="margin-top: -15px" for="name-a" class="ui-input-text" >Texte :</label>
                    <textarea cols="40" rows="8" name="textarea" id="textarea" class="ui-input-text ui-body-null ui-corner-all ui-shadow-inset ui-body-c ui-focus"/>
                </div> 
                
                <div class="ui-body ui-body-b">   
                    <div data-theme="d">  
                       <button type="submit" data-theme="d" class="ui-btn-hidden" aria-disabled="false">Annuler</button>
                    </div>
                     <div data-theme="d">  
                       <button type="submit" data-theme="a" class="ui-btn-hidden" aria-disabled="false">Envoyer</button>
                    </div>          
                </div>
            </div>
        </div>
    </body>
</html> 